DESCRIPTION: (Applicant's Abstract) The need to expand methadone treatment and related health care services for women with or at risk for HIV/AIDS has been frustrated by the limitations of current models of care. Specialty methadone clinics often separate addiction treatment from primary care and reproductive health services, fragmenting medical management and marginalizing the very syndrome (addiction) that lies at the core of the problem. By developing the capability of primary care practitioners and specialists in women's health care to treat methadone patients within their office or health center practice, we have the potential to foster greater integration of medical care and addiction treatment. The proposed study is a randomized clinical trial in which an office-based practitioner model for the prescription of methadone is compared to usual care in a Methadone Maintenance Treatment Program (MMTP). The study will focus on the special treatment issues of women, who are at higher risk for AIDS and have greater routine medical care needs than men. Our specific aims are: 1) to determine if women currently enrolled in MMTP can be transferred to office-based medical practice and retained at rates equivalent to those in MMTPs; 2) to determine if the use of illicit opiates will not increase under this model of care; and 3) to assess the impact of incorporating methadone prescribing for women into non-specialist medical care settings and practices. The study will be conducted in stages over a three year period: 1) eligibility screening; 2) a 3-month baseline study period with monthly study visits for 150 women attending MMTP; and 3) randomization to experimental (office-based methadone) or control groups (MMTP) for 50 women in each group with one year of follow-up in treatment. We operate an extensive MMTP with over 1200 eligible patients and have recruited a group of clinicians at our institutions prepared to assume these responsibilities. If successful, office-based methadone prescribing has the potential to increase the number of patients cared for and the number of clinicians skilled in addiction medicine necessary first step toward the ultimate objective of making methadone treatment more available and anticipating the changes associated with the introduction of managed care.